The aim of review. To present modern concept on pathogenesis, up-to-date diagnostic criteria and approaches to treatment of hepatorenal syndrome (HRS).

Original positions of the review. At the last years in pathogenesis HRS, the role of cardiac and adrenal incompetence is discussed along with «classical hypothesis of peripheral vasodilation». It is shown, that in patients with HRS no adequate enhancement of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) activity is observed, that is related to development of specific cardiomyopathy at liver cirrhosis (LC). In development of adrenal failure at HRS addition of severe bacterial infection, activation of inflammatory mediators and activation of endogenous vasoconstrictors effects play a role. In 2005 in San Francisco new HRS diagnostic criteria for LC patients were proposed, that essentially reduces rate of false-positive HRS diagnostics. In relation to clinical severity and prognosis two HRS forms are defined. Application of vasoconstrictors (terlipressin) in combination to albumin considerably reduces severity of HRS of the 1-st type and allows to carry out liver transplantation (LT) which is a method of choice for these patients.

Conclusion. HRS is dreadful complication of acute and chronic liver diseases. In development of circulatory dysfunction at HRS, besides peripheral vasodilation, cardiac and adrenal failure play a major role. New diagnostic HRS criteria for LC patients are defined. Application of terlipressin and albumin increases survival rate of HRS patients and allows to carry out LT.

The aim of review. To describe the compensatory and adaptive processes regulating neogenesis of liver after its damage. To present the methods of stimulation of liver regeneration at cirrhosis.

Original positions of the review. Results of scientific studies allow to qualify hepatocytes as unipotent committed population of stem cells, capable to sustain constance of structure and function of liver at damage due to any cause. The factors, both intrahepatic and extrahepatic, interreacting among themselves and with specific receptors of cellular membranes, control this compensatory mechanism. Several methods to stimulate regenerative processes at liver cirrhosis were proposed including most widely applied use of recombinant growth factors, transplantation of fetal hepatocytes and bone marrow stem cells as well as various types of dosed damage of liver tissue.

Conclusion. Knowledge of mechanisms of compensation of structure and function of the liver has the important practical value for development of methods of treatment of various diseases. In particular, in patients with cirrhosis modulation of neogenesis processes is expedient both for treatment of disease and its complications, and for orthotopic liver transplantation lead-up.

Aim of investigation. To study a state of the first and second lines of local host defense in relation to severity of stomach mucosa (SM) atrophy, Н. рylori infection at chronic gastritis.

Materials and methods. Sixty-eight patients with chronic H.pylori-associated gastritis (CG+) and 31 patients – with chronic multifocal atrophic gastritis (CMAG) were investigated. Control group – 27 generally healthy volunteers. Samples for investigation were obtained at gastroduodenoscopy.

Results. Comparison of sIgA concentration scores in relation to severity of SM atrophy revealed increasing deterioration of the first line of protection in the sequence from CG(+) with no or mild SM atrophy to CG(+) with 2–3 points SM atrophy and then to patients, having CMAG. Thus the first line of local immunodefence at CMAG showed another quality of sIgA production in response to Н.рylori infection. Severe depression of sIgA production was combined to wide-spread atrophy of SM and high frequency of Н.рylori infection (29 of 31 cases) on a background of significantly lower density of SM contamination by H.рylori. In controls and in CG(+) patients with absence or mild atrophy of SM positive correlation between sIgA concentration and IgA has been found. Detected correlation links were lost in group of CG(+) with severe atrophy and CMAG, that was combined to significant negative correlation between sIgA and IgG. Besides this, significant positive correlation has been found in CG(+) patients with SM atrophy of 2–3 points between IgG level and degree of neutrophilic infiltration.

Conclusion. Development and progression of chronic inflammation in the stomach develops at close interaction of three major factors: immune, contagious and morphological. At CG Н. рylori aggressive potential is realized at decline of the first line of host defense which activity, in turn, depends on severity of atrophic changes of SM. Weakening of sIgA in gastric juice at patients with CG increases activity of the second line of host defense and maintain chronic inflammation in SM.

Aim of investigation. To determine genetic polymorphism of interleukin-1β at mixed population of Moscow and Moscow region and to estimate its impact on efficacy of H. pylori eradication therapy.

Materials and methods. Overall 82 patients with peptic ulcer of the stomach and duodenum associated to H. pylori were investigated in a prospective cohort study according to general standards. All patients underwent first line eradication therapy for 7 days.

Results. Results of original study in Russian population confirm foreign data that genetically determined variation of interleukin-1b production affects efficacy of H. pylori eradication.

Conclusions. Presence of proinflammatory T-allele increases probability of success of eradication therapy that can be utilized for selection of risk groups and targeted treatment.

Aim of investigation. An objective evaluation of efficacy, safety and features of application of argon plasma laser coagulation (APC) for hemostasis and prophylaxes of ulcerative gastroduodenal bleedings (UGDB) in comparison to well-known and investigated method of endoscopic hemostasis – bipolar diathermocoagulation (BiDC).

Materials and methods. From March, 2006 to May, 2008 according to approved protocol of prospective randomized scientific study 50 patients with acute UGDB have been enrolled in the program.

Results. Primary endoscopic hemostasis by the selected method has been achieved in all 25 (100%) patients in APC group and at 24 (96%) of 25 patients in BiDC group. Isolated APC was done at 22 (88%) patients, BiDC – at 18 (72%); respectively 3 (12%) patients in APC group and 7 (22%) in BiDC group required combined application of coagulation and injection methods according to the investigation protocol.

Conclusion. Analysis of main results of prospective randomized study shows, that two methods have equal capabilities on basic efficiency in hemostasis and prophylaxis of UGDB relapses, and also equal degree of safety. Irrespective of the applied method of primary endoscopic hemostasis the major factor of non-surgical hemostasis at UGDB is application of complex pharmaceutical treatment with adequate antisecretory therapy by proton pump inhibitors.

Aim of investigation. To study potential of application of serum phospholipids (PL), intensity of lipid peroxidation (LP) and total serum anti-oxidative capacity (TAC) parameters as non-invasive markers of disease activity at a chronic viral hepatitis C (CHC).

Materials and methods. Ninety patients with CHC were investigated, of them 32 were monitored at combined antiviral therapy (AVT). Level of PL in blood was determined by Trinder method, TAC of blood serum – by microtablet colorimetric method. Level of LP was estimated by malonic dialdehyde (MDA) using reaction with thiobarbituric acid. PL, MDA and TAC were investigated before and after treatment.

Results. Significant decrease of PL saturation of blood serum was detected at investigated patients, contents of MDA and level of TAC have been elevated. No relation of investigated parameters to AlAT activity was revealed, but negative correlation between PL level and histological activity index (HAI) and positive correlation between MDA and HAI, АОС and HAI were revealed. Investigated parameters did not depend on index of fibrosis. During the course of AVT blood MDA content and АОС activity were decreased. PL concentration has increased, however remained lower than at healthy controls. It was concluded, that serum PL, LP and anti-oxidative protection parameters can be used as non-invasive markers of inflammation activity. Low blood saturation of PL, and absence of normalization of their level at AVT give theoretical prerequisites for application of essential PL drugs as adjuvant therapy for CHC patients.

Aim of investigation. To estimate risk of complications at patients with acute alcohol-induced hepatitis (AAH) and survival rate of this given category of patients on background of the complex therapy including chophytol.

Materials and methods. Sixty-seven patients with AAH, without concomitant liver cirrhosis, taking 12 and more alcohol drinks per day (500 g and more as equivalent to vodka) before admission to hospital were investigated. The diagnosis was established basing on routine laboratory and instrumental methods.

Results. It was found, that AAH as manifestation of alcoholic liver disease has a number of specific clinical and laboratory features. Maddrey’s discriminant function, manifestations of hepatocellular failure syndrome, hepatic encephalopathy up to hepatic coma and hepatorenal syndrome (HRS) have the highest prognostic value in these patients, their development is associated with high mortality. Addition of parenteral form of chophytol to complex therapy at AAH positively influenced course of disease, of cytolytic, cholestatic and hepatoprival syndrome dynamics. Besides, the augmented variant of treatment had hyponitremic action and promoted improvement of renal function, that significantly reduced frequency of HRS development and associated mortality rate.

Conclusions. Prediction of fatal complications at AAH patients allows to carry out diagnostics at early stage and choose adequate therapeutic methods. Adding of chophytol parenteral injection 10 ml per day for 1–3 months to traditional glucocorticoid, anticytokine and detoxication drugs is one of treatment approaches in severe form of AAH (Maddrey’s discriminant function over 32), that prevent development of complications, in particular HRS.

Aim of investigation. To assess etiological factors of hepatocellular carcinomas (HCC) and prognostic value of б-fetoprotein level in retrospective study.

Materials and methods. Case records of 103 HCC patients and 244 patients with liver cirrhosis, that underwent investigation by standard laboratory and instrumental methods were analyzed.

Results. 103 patients with HCC were investigated: in 65 (63,1 %) the tumor has developed on a background of liver cirrhosis (LC), in 38 (36,9%) – on a background of non-cirrhotic diseases. Etiology of LC, precursor of HCC included: HBV – 24,6%, HCV – 9,2%, alcohol – 53,9% of cases. In comparison to original data, published previously by same authors, decrease in number viral and increase of alcoholic LC was marked. The etiological spectrum of non-cirrhotic liver diseases as a background for HCC, was close to that in LC. 244 patients of the LC were investigated. Patients were monitored for 4,3 years. Of 55 cases with initially elevated level of b-fetoprotein HCC has developed in 11 (20,0%), of 189 patients with normal level – in 3 (1,6%).

Conclusions. Alcohol-induced LC and steatohepatites, as well as similar viral liver diseases, are risk factors of HCC and are subject to dynamic cancer surveillance. Patients of the LC with high b-fetoprotein level require especial careful observation for HCC screening at asymptomatic (early) stage.

Aim of investigation. To estimate efficacy of endoscopic bilioduodenal stenting in treatment of patients with neoplastic and postoperative scar stricture of extrahepatic bile ducts.

Materials and methods. Overall 372 patients have been included in the study. In 98,6% of the cases obstructive jaundice was the leading clinical sign of the disease. After verification of the diagnosis in all cases endoscopic bilioduodenal stenting was attempted.

Results. Of 42 patients with postoperative bile ducts stricture in 31 (73,8%) cases obstruction of bile outflow was possible to remove endoscopically. Complications have developed in 7,1% of cases, mortality was 2,4%. Good long-term results were obtained in 95,6% of cases. From 330 patients with neoplastic biliary occlusion in 234 (70,9%) stenting of bile duct was possible to execute. Complications have occurred in 38 (11,5%) of patients, mortality – was 14,1%.

Conclusions. Efficacy of bilioduodenal stenting in treatment of obstructive jaundice is up to 73,1%. At fibrotic postoperative strictures this method can be an alternative to surgery, at neoplastic strictures it can be applied for preparation for surgery or as final treatment.

The aim of review. To define etiological factors, features of clinical pattern and up-to-date approaches to treatment of travellers diarrhea.

Original positions of the review. Travellers diarrhea most often develops at visits to tropical countries. In the majority of cases low sanitary-and-hygienic level in host country contributes to its development, and etiological agent is enterotoxigenic strains E. coli. The basic role in treatment is given to rehydration therapy, and prescription of antibiotics. Thus nonabsorbable antibiotics (rifaximin) have a lot of advantages in comparison to systemically acting antibiotics.

Conclusion. Keeping of prophylactic measures allows to decrease the risk of development of travellers diarrhea, and rehydration therapy with prescription of nonabsorbable antibiotics helps to stop clinical signs of disease faster.

Aim of investigation. To study clinical and epidemiologic features of inflammatory bowel diseases (IBD) and their relation to TNF-a, and СD14 genes polymorphism in Novosibirsk population.

Materials and methods. According to medical aid appealability and archival documents, data for 527 IBD patients were obtained: 375 had ulcerative colitis (UC), 277 – Crohn’s disease (CD) and 28 – «indeterminate» colitis. Clinical analysis was carried out by type and course of disease, localization and prevalence of process. In 120 patients (57 – with CD, 63 – with UC) frequency of TNF-a (–G308A) and СD14 (–С260Т) genes polymorphism was studied in comparison to population data.

Results. Clinical and epidemiologic characteristics of patients with IBD in Novosibirsk essentially do not differ from the scores obtained in other regions of Russia. Frequency of TNF-a gene –G308A polymorphism in city inhabitants with IBD, significantly differed from population data: genotype А/А at IBD was detected 4,7 times, and at CD – 7,7 times is more frequently, than in general population, A allele carriage was 1,7 and 2,2 times more frequent respectively. Frequency of CD14 gene –С260Т polymorphism at IBD also significantly differed from population: С/С genotype at IBD is revealed 1,8, and at UC – 2,2 times more frequently, than in general population, frequency of Т/Т genotype is 2,5 times higher at CD, than in general population.

Conclusion. Contribution of the revealed gene polymorphism to IBD predisposition at Novosibirsk inhabitants is quite high. Further studies are necessary.

Aim of investigation. To analyze clinical, diagnostic features and some mechanisms of development of the stomach and duodenum lesions on a background of chronic obstructive pulmonary disease (COPD).

Materials and methods. One hundred of patients with chronic obstructive disease of lungs were investigated. Clinical, endoscopic, morphological, roentgenological, immunologic methods, pulse-oximetry were applied. Results. Higher smoking index (38,81 packs /years) was found at increase of COPD severity stage and aggravation of inflammatory and atrophic changes of gastric and duodenal mucosa (34,18 packs /years). Erosive and ulcerative lesions of this area were significantly more frequently found at increase of respiratory failure (RF): in 27,3% of patients – at the I stage of RF, in 41,5% – at the II stage of RF (р<0,05). In turn, the stage of RF correlated to smoking index (r=0,535). Conclusions. Interrelation between severity of lesions of the stomach and duodenum in patients with chronic obstructive pulmonary disease, smoking index and baseline therapy was revealed. The significant role of disorders of immune, autoimmune and cytokine homeostasis in development of these lesions is demonstrated.>< 0,05). In turn, the stage of RF correlated to smoking index (r=0,535).

Conclusions. Interrelation between severity of lesions of the stomach and duodenum in patients with chronic obstructive pulmonary disease, smoking index and baseline therapy was revealed. The significant role of disorders of immune, autoimmune and cytokine homeostasis in development of these lesions is demonstrated.

The aim of clinical case presentation. To show diagnostics and treatment features of stomach leiomyomas at the example of original case presentation.

Features of clinical observation. Patient had asymptomatic course of large gastric leiomyoma. The neoplasm has been revealed accidentally at planned dynamic endoscopic control due to polyp of the stomach in past history of the patient. Leiomyoma has been removed not by major surgery with laparotomic access, but with the help of laparoscopic stomach resection.

Conclusion. Nowadays there is a complex of instrumental diagnostic methods that allows to verify precisely the diagnosis of stomach leiomyoma. In treatment of this tumor noninvasive surgery can be successfully applied.